Healthcare Provider Details

I. General information

NPI: 1083450886
Provider Name (Legal Business Name): CODY JAMES SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 N I 10 SERVICE RD W
METAIRIE LA
70006-6713
US

IV. Provider business mailing address

5213 PIKE DR
METAIRIE LA
70003-2735
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-9270
  • Fax:
Mailing address:
  • Phone: 504-373-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: